From the Guidelines
Nasal fludrocortisone is not a typical route of administration for this medication, and thus, it does not significantly raise serum steroid levels. When considering the administration of fludrocortisone, it's essential to note that it is almost exclusively given orally as tablets to treat conditions like adrenal insufficiency and orthostatic hypotension, as stated in the consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency 1. The standard doses of fludrocortisone, which range from 50–200 µg daily, are absorbed systemically and can be detected in serum, but they primarily affect mineralocorticoid receptors rather than significantly elevating overall steroid levels. Some key points to consider about fludrocortisone and its administration include:
- The medication is typically taken orally, not nasally, to treat adrenal insufficiency and other conditions.
- Oral fludrocortisone has minimal systemic absorption and primarily affects mineralocorticoid receptors.
- Nasal corticosteroids, such as fluticasone, mometasone, or budesonide, are the ones typically used intranasally and have negligible effects on serum steroid levels when used at recommended doses, as they are preferred for long-term management of allergic rhinitis and other nasal conditions. Given the information provided in the consensus statement 1, it's clear that fludrocortisone is not intended for nasal administration, and its oral administration does not significantly raise serum steroid levels.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Nasal Fludricortisone and Serum Steroid Levels
- The provided studies do not directly address the effect of nasal fludricortisone on serum steroid levels.
- However, studies on similar corticosteroids, such as fluticasone propionate, suggest that they have low systemic activity and do not cause significant adrenal suppression 2, 3.
- One study found that intranasal fluticasone propionate in a dosage of up to 4 mg/day does not cause adrenal suppression, indicating minimal systemic availability 2.
- Another study noted that long-term use of intranasally administered corticosteroids, including fluticasone propionate, has not caused hypothalamic-pituitary-adrenal (HPA) suppression 3.
- A study on the combination of azelastine and fluticasone propionate found that it reduced nasal symptoms more effectively than either medication alone, but did not discuss serum steroid levels 4.
- A study on the gene expression profiles in response to azelastine and fluticasone propionate combination or monotherapy found that the combination had diverse effects on immune gene expression profiles in nasal mucosa samples, but did not address serum steroid levels 5.
- A review of systemic absorption and side effects of locally injected glucocorticoids found that there is significant individual variability in the amount of systemic absorption and clinical effects, and that both intra-articular and epidural injections can have systemic effects for weeks 6.